Integrative medicine approaches to cancer-related cognitive impairment

Integrative Medicine

While the adverse effects of chemotherapy are well known, cognitive impairment—also known as “chemo brain” or “chemo fog”—has only recently gained greater recognition by clinicians. Evidence now suggests that impaired memory, concentration, and executive functioning such as multitasking may be present in almost one-third of patients before treatment, and in some individuals, these effects may persist for years following treatment.1 The cognitive impairment can significantly affect quality of life and job performance, resulting in depression and stress.


The underlying mechanisms for the cognitive impairment are unknown; alterations in brain structure and function and increased concentrations of inflammatory cytokines may be contributing factors, as well as genetics. Although preliminary data have suggested a benefit with modafinil, some nonpharmacologic approaches such as exercise, cognitive behavioral therapy, and cognitive training have demonstrated consistent improvements.


Mind–body practices


Breast cancer remains the most common cancer in American women, with more than 220,000 women diagnosed in 2011.2 Among Hispanic women, it is the most common cause of death from cancer. Fortunately, early detection and treatment have improved survival for many women.


Multiple studies have evaluated the potential benefits of mind–body practices for supportive care, including cognitive dysfunction of patients after cancer treatment. Yoga has been reported to improve cognitive symptoms, as well as fatigue and inflammation, following treatment for breast cancer. One study randomized 200 breast cancer survivors to either 90-minute Hatha yoga sessions twice weekly for 12 weeks or to a wait list control group. 


Women in the wait list group performed their usual daily activities but were asked not to participate in yoga activities. The women were between 27 and 76 years of age and predominantly Caucasian; a total of 181 completed the study. At the 3-month follow-up, cognitive complaints were 23% lower in the group receiving the yoga intervention. More frequent participation in yoga was associated with greater improvement in symptoms.3

Ginkgo biloba


A recent placebo-controlled study evaluated ginkgo biloba 60 mg twice daily in women who were newly diagnosed with breast cancer. Participants were chemotherapy-naive and were enrolled before their second round of adjuvant chemotherapy.4


The High Sensitivity Cognitive Screen (HSCS) was used to assess memory, language, attention/cognition, and other components. In addition, investigators used the Trail Making tests A and B to measure cognition, as well as the Profile of Mood States (POMS) and the cognitive subscale of the Perceived Health Scale (PHS). Participants were assessed at baseline, during chemotherapy, and at multiple intervals after the end of treatment up to 2 years following completion of therapy. 


Of the 210 participants at baseline, 166 completed the study. The population had equal numbers of premenopausal and postmenopausal women. The ginkgo-treated patients did not differ from the placebo-treated patients in the HSCS subscales or on Trail Making tests A and B. In addition, the confusion subscale of POMS and the cognitive component of PHS did not show a benefit.4

What to tell patients


Many patients who have developed cancer and/or received treatment have reported memory impairment and other changes. Symptoms may persist in some individuals after treatment. Regular aerobic exercise may help with mood and memory problems in patients with cancer-related cognitive impairment. 


In addition, memory aids may be helpful for coping with cognitive changes. Yoga and tai chi may be beneficial when done regularly and as tolerated by the individual.


References

  1. Int Rev Psychiatry. 2014;26(1):102–13
  2. www.cdc.gov/cancer/breast/statistics/index.htm
  3. Psychooncology. 2014;21;[Epub ahead of print]
  4. Support Care Cancer. 2013;21(4):1185–92